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General NPI Number Information
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NPI Number | 1750193090
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Entity Type | Individual
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Provider Name | SEUNGHOON PAUL LEE LAC
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Gender | Male
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 12778 SE STARK ST BLDG B
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City | PORTLAND
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State | OR
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Zip | 97233-1539
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Country | US
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Telephone | 503-317-3113
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Fax | 503-459-4709
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Provider Business Mailing Address
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Address Line | 411 NW FLANDERS ST APT 609
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City | PORTLAND
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State | OR
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Zip | 97209-3856
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Country | US
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Telephone | 571-245-0694
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC213507
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License Number State | OR
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